Real-time three-dimensional transesophageal echocardiography in transcutaneous, catheter-based procedures for repair of structural heart diseases

Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms

BACKGROUND

Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view.

AIM

To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding.

METHODS

Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure.

RESULTS

A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients' age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months.

CONCLUSION

Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.

Advanced Imaging Techniques for Mitral Regurgitation

Mitral regurgitation (MR) is one of the most commonly encountered valvular lesions in clinical practice. MR can be either primary (degenerative) or secondary (functional) depending on the etiology of MR and the pathology of the mitral valve (MV). Echocardiography is the primary diagnostic tool for MR and is key in determining this etiology as well as MR severity. While clinicians usually turn to 2 Dimensional echocardiography as first-line imaging, 3 Dimensional echocardiography (3DE) has continually shown to be superior in terms of describing MV anatomy and pathology. This review article elaborates on 3DE techniques, modalities, and advances in software. Furthermore, the article demonstrates how 3DE has reformed MR evaluation and has played a vital role in determining patient management.

Mitral valve prolapse: role of 3D echocardiography in diagnosis

PURPOSE OF REVIEW

To review the utility and the latest developments in three-dimensional (3D) echocardiography of mitral valve prolapse.

RECENT FINDINGS

Although 3D echocardiography was invented in 1974, it did not gain wide clinical acceptance until the introduction of real-time 3D echocardiography in the first decade of the 21st century. Driven by improvements in probe technology and increases in computing power, 3D echocardiography now provides unprecedented images of mitral valve prolapse and its associated mitral regurgitation with no or minimal requirements for image post processing.

SUMMARY

3D echocardiography has become the echocardiographic modality of choice for establishing the diagnosis, describing the precise anatomy, and visualization of mitral regurgitant jets in mitral valve prolapse. 3D echocardiography is becoming indispensable in guiding surgical and percutaneous methods of mitral valve repair and replacement.